Self-management of Osteo-Arthritic knee

By

Mohammad Khairul Anuar Bin Pehin Haji Hasrin,

Physiotherapy Dept, RIPAS Hospital

Osteo-arthritis is a wear and tear process occurring in joints in the body that are under the most stress eg the knee, hip, lower back and neck. Many people are affected by this condition although it is mainly the middle-aged or elderly who is affected, younger people, as early as thirty can show mild arthritic symptoms.

ANATOMY
The knee joint is made up of two bones of the thigh and lower leg - the femur and tibia. They have a smooth polished surface at their end called cartilage. The cartilage allows free gliding movement between the two bones. It also acts as a shock absorber. A strong bag-like membrane called the capsule surrounds the whole joint. It is reinforced by ligaments, which bind the joint together. Inside the capsule is the joint fluid (synovium). The joint fluid is important in lubricating the joint and nourishing the cartilage. Each of these structures is involved in the wear and tear process of osteo-arthritis.

PATHOLOGY
In osteo-arthritis of the knee, the cartilage becomes roughened and begins to thin out in the part of the joint where usually more weight is borne or sometimes where no movement occurs - eventually patches of bone are exposed. The exact initiating factor is still uncertain, but the condition will be aggravated by a combination and variety of factors, which include the durability of cartilage, the natural ageing process, over use or lack of use, a previous injury and excess weight.

RESULTS
The surrounding capsule and ligaments respond to these changes by a stiffening process. The effects are felt after a period of inactivity. The stiffening loosens up with movement. As the joint surfaces become closer and less smooth, movement becomes less supple. Reduced shock absorption makes the knee more vulnerable to stress, so that aching follows any stress more readily.

ACTION NEEDED
Once the cartilage has worn away, it cannot be replaced, therefore you should aim to conserve your cartilage. This can be done by reducing stress to the cartilage and keeping the cartilage well nourished, which it receives from the joint fluid. These nutrients have to be squeezed into the cartilage by the pressure of movement, otherwise the cartilage starves. Thus the nutrients have to be pumped into the area by muscular movement and then squeezed into the cartilage.

DO's AND DON'Ts

Joint Mobility
Don't be immobile - Long periods of immobility should be avoided as it means there is no squeezing effect of the joint fluid into the cartilage.
Do be mobile - Keep your knee movement full. Allowing your knees to stiffen and lose some movement at extreme straight or bent positions will restrict your activities and reduce nourishment to the cartilage.

Compression Of The Joint
Don't compress your joints excessively - For example, long bouts of standing, walking or running; sudden impact on your joint (running on concrete, stepping awkwardly down steps); being overweight or carrying extra weight (shopping or carrying young children for too long) Also try to be and maintain your optimum weight.

Do ease off weight on joint regularly - Keep shifting from one foot to the other; sit down to take weight off your feet whenever possible; use a walking stick to help reduce the weight going through the joint.

Do compensate for the loss of shock - Step carefully down steps; wear correct footwear with good shock absorbing soles (eg crepe or sorbo-rubber); when kneeling, use a foam cushion.

Twisting The Joint
Don't twist the joint - This stressful movement eg. getting up from the floor, will grind the joint surfaces together and strain the ligaments and capsule.

Do avoid twisting the joint - Avoid having to get up from the floor or sitting back on your heels; wear low heel shoes; sit with your leg uncrossed.

Strength Of Surrounding Muscles
Don't let leg muscles weaken - If this happens, the support of the knee joint is reduced, and your knee will be more vulnerable to strain.

Do protect your joint by keeping muscles strong by exercising them.

PRACTICAL TIPS AT HOME TO HELP EASE YOUR ACHES AND PAINS
Wear knee supports or bandages - Their warmth and gentle pressure may help to ease your symptoms.
Massage around your knee - Gentle but firm circular kneading movements with the pads of your fingers may help ease the symptoms of stiffness around your joint.
Heat applied to the joint - This can help reduce the sensation of pain experienced. Use a quarter filled hot water bottle, filled with 'bath hot' water. Apply to your knee and leave for 15-20 minutes, this should feel very comfortable.
Cold may be more effective for some people, especially if heat tends to make no difference. Crush ice cubes in a dampened face flannel and apply to your knee. Allow approximately 10-15 minutes. Your knee should be slightly pink at the end.

Ministry of Health Public Awareness Programme

(Ref: A Practical Guide To The Care And Protection Of The Osteo-Arthritic Knee - Written By Chartered Physiotherapists, United Kingdom)

Source: Weekend 7 Feb 2009